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Bacterial meningitis in Denmark. Discrepancy between laboratory registered and notified cases

Abstract number: 10.1111/j.1198-743X.2004.902_o198.x

Meyer C.N.

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Objectives:

Treatment recommendations for bacterial meningitis (BM) are to a large extent based on notified cases, but notification rates have been reported to be incomplete. We wished to determine the variation in notification rates among cases of verified BM with positive microbiology.

Methods:

Cases of BM was identified in the laboratory information systems of 12 of 15 existing Danish departments of clinical microbiology (dpt.cm) in the year 2002 (population served 4 520 000). Cases were included if positive cultures of cerebrospinal fluid were accompanied by clinical and biochemical findings compatible with BM and contamination was effectively ruled out. Patients with positive blood cultures and a diagnosis of BM resting on clinical and biochemical findings were also included. Four dpt.cm supplied data on CSF culture-negative and blood-culture positive cases. Neuro-surgical cases and mycobacterioses were excluded. The National Notification System for Infectious Diseases supplied relevant data. Capture–recapture methods were not performed because of population differences.

Results:

A total of 196 culture positive cases of BM were identified in a population of 4 520 000. S. pneumoniae constituted 88 cases (45%), N. meningitidis 35 cases (18%), S. aureus 14 cases (7%), E. coli eight cases (4%), L. monocytogenes six cases (3%), E. faecalis four cases (2%), streptococci 23 cases (12%), H. influenzae two cases (1%), miscellaneous bacteria 16 cases (8%). Of these 196 cases, 78 cases (40%) were not notified. The notification rate for S. pneumoniae was 88% (77 of 88), for N. meningitidis was 97% (34 of 35), for S. aureus 7% (one of 14), for E. coli 0% (0 of eight), for Listeria 83% (five of six), for E. faecalis 0% (0 of four), for streptococci 13% (three of 23), for H. influenzae 50% (one of two), and for misc. bacteria was 25% (four of 16).

Conclusion:

Notification rates among cases of BM varies according to bacterial aetiology. If recommendations for empirical treatment is based on notification data only, there is a risk of insufficient initial antibiotic treatment for underreported bacterial agents.

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Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
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